Medicare Adjusts Readmissions Penalties

For the second time in 6 months, Medicare has erred in calculating hospital readmission penalties for more than 1,000 of the nation's hospitals, says a Kaiser Health News article.

As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its Hospital Readmissions Reduction Program. The penalty imposed on St Claire Regional Medical Center in Morehead, Kentucky, will drop the most, from 0.93% to 0.72% of every payment Medicare makes for a patient during the fiscal year that ends in September.

Medicare also modestly increased the penalties for 226 hospitals. LaSalle General Hospital in Jena, Louisiana, will see its penalty grow by the greatest percentage. LaSalle will lose 0.84% of each Medicare payment per patient, instead of the 0.65% reduction Medicare previously announced.

The payment changes for most hospitals were small, averaging .03% of each reimbursement. Overall, hospitals will pay $10 million less in penalties than previously calculated, for a total of $280 million this year. The changes are retroactive to October 2012, when the program began.

The readmission program, created by the Afforadable Care Act, is looking at the number of patients with heart attack, heart failure, and pneumonia who return to the hospital within 30 days of discharge. Hospitals with more readmissions than Medicare expected given their mix of patients are penalized by losing up to 1% of their regular payments. The maximum penalty ramps up to 2% starting this October and grows to 3% in 2014.

Medicare originally released the penalties last August, but then revised them at the end of September after determining that it had left some patients out of its calculations. That change increased penalties for 1,422 hospitals and decreased them for 55 others.

This second correction brings many hospitals closer to where they originally were, says Kaiser. More than 320 hospitals that had their penalties altered in September now will have their initial penalties restored.

Physical therapists can help serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. For more information and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage.